Determinants of low uptake of second dose of measles rubella vaccine among under five children in Nsanje district
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Date
2021-09-13
Authors
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Journal ISSN
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Publisher
Kamuzu University of Health Sciences
Abstract
Background Information::
The government of Malawi through the expanded programme in immunization introduced the second dose measles containing vaccine (MCV) into the routine immunization schedule in 2015. In 2017, Malawi government introduced the integrated measles and rubella containing vaccine (MRCV). Measles-rubella vaccine is a two-dose vaccine which is administered at 9 months (1st dose) and 15 months (2nd dose). Immunization uptake of measles rubella second dose vaccine is very low in Malawi. There is a need to get to the root causes of this trend since partial immunization poses a health threat to the children.
Study Design and Setting The research will be an analytical cross-sectional study design which will purposively focus on catchment areas of 5 health centres, one from each zone. Birth cohort of children born between 1st October 2016 and 30th April 2018 shall be the target population. Eligible children shall be sampled and visited to establish vaccine completion status and explore associated factors from care givers. A “care giver” shall be any individual responsible for everyday welfare of every child including vaccination compliance. The study shall be conducted in the southern region of Malawi in a district called Nsanje.
Study Objectives::
The study will assess proportion of children who completes two doses and will also explore
factors associated with the completion trend. The study will focus on both service-user and service-provider related factors.
Rationally
Since its introduction in Nsanje district on 1st July 2017, immunization coverage of measles rubella first dose has been above 90% which is above the national target of 80% and above World Health Organization target of 85%. On the other hand, completion of second dose of this vaccine is a problem. Administrative data for Nsanje district suggests that immunization coverage for the second dose is below 40% despite that it has been more than 3 years post introduction of measles rubella vaccine in the district. The study which will establish completeness status of two doses of measles rubella vaccine and explore associated contributory factors for the situation.
Methodology and Data Analysis::
Data shall be collected at community and health facility level using a questionnaire. At
community level, all villages under sampled health centres shall make up the sampling frame.
Sampled children shall be visited and a questionnaire shall be administered to caregivers. At this stage individual factors shall be explored. Individual factors are factors affecting each participant in regards to vaccine utilization. These include literacy levels, education level, birth order etc while community factors are factors which affect participants collectively like culture, distance, etc. At health centre level, a questionnaire shall be administered to the Senior Disease Control Assistant which shall assess health facility related factors contributing to the current status. Health facility-related factors shall be those factors related by the management and administration of vaccines. These include stock outs, cold chain maintenance, documentation, defaulter follow-ups, scheduling of clinics and cancellations. Raw data shall be entered on excel and imported to Stata 15. Logistic regression model shall be used for statistical analysis. All socio-demographic variables will be entered into a multivariate logistic model, while other variables will be considered based on a cut-off p-value (<0.1) after testing multi-collinearity between all variables. The analysis will be carried out for caretakers and health workers
separately in STATA version 15, and survey weights will be specified to account for sampling design in generating results and will include odds ratios (OR) and 95% confidence.
Research Ethics::
The research shall involve data of human subjects. To ensure safety of participants all ethics
shall be considered. First approval shall be obtained from COMREC, second approval shall be
obtained from Director of Health and Social Services. Third approval shall be obtained from
community leaders and final approval shall be obtained from each participant. Collected data
shall be well secured by the principal investigator in order to protect subjects.
Research Findings::
Once the research findings confirm that more children don’t complete measles rubella
vaccination and its associated factors, it shall be an eye opener to Nsanje district council, the expanded programme on immunization, partners and community. The outcome shall be utilized for evidence informed decision and policy making. The results shall be the basis for the district to design interventions aiming at addressing the problem.
Dissemination of Findings::
The results shall be published in a journal and disseminated to COMREC, Nsanje district
council, the expanded programme in immunization, participating community and partners.